Leads for selective sensing and virtual electrodes

ABSTRACT

Selective sensing implantable medical leads include pulsing and sensing portions and pulsing and not sensing portion. Leads and electrodes may be used in defibrillation and as integrated bipolar defibrillation electrodes. An entire electrode can pass charge while a valve metal or valve metal oxide portion of the electrode prevents the entire electrode from sensing, effectively rejecting unwanted signals. Differential conduction pathways, due to the valve metal and/or oxides thereof, cause the portions of the electrodes to conduct differently when used anodically and cathodically. Complex intracardiac electrical gradient can be formed along with a number of virtual electrodes within the tissue. Reentrant loops can thereby be pinned following defibrillation shock.

INTRODUCTION

The present technology relates to leads and electrodes for sensing andpulsing, for example, implantable medical leads for coupling to animplantable medical device (IMD).

A wide variety of IMDs are used in the human body. IMDs can bemanufactured as discrete units that may be selected by a physician for aparticular clinical use and coupled at implantation with one or moremedical electrical leads. IMDs may include an implantable pulsegenerator (IPG) or a physiologic monitor, and particular examplesinclude cardiac pacemakers, cardioverter/defibrillators, cochlearimplants, muscle and nerve stimulators, and deep brain stimulators. Suchdevices often include signal processing and/or pulse generatingcircuitry powered by a battery and enclosed within a hermetically sealedenclosure or housing, which may be referred to as a “can.” The can istypically formed of a conductive and biocompatible metal, such astitanium, which is corrosion resistant when exposed to body fluidsduring chronic implant. A connector header attached to a mountingsurface on the can enables coupling of the IMD with one or more leads,whereby electrical connection is made between lead electrodes and thecircuitry enclosed within the housing.

Electrical leads typically support one or more stimulation and/orsensing electrodes and certain IMDs may employ all or part of the can asan electrode. The conductive surface of the can may operate inconjunction with one or more of the lead electrodes to deliverstimulation energy, sense electrical body signals, and/or senseimpedance changes in tissue. For example, in the delivery of cardiacpacing pulses, the can may act as an anode or indifferent electrode inconjunction with a lead cathode, and for the delivery of monophasic orbiphasic cardioversion/defibrillation shocks, the conductive surface ofthe can may act as a high voltage electrode in conjunction with at leastone lead electrode of an opposite polarity.

Where the IMD operates as a defibrillator, for example, one or moreelectrical leads are coupled to a device that is implanted in asubcutaneous pocket, with the lead(s) extending therefrom via atransvenous route into a patient's heart in order to carry electricalpulses from the device. These electrical leads may be used for pacing,sensing, and/or defibrillation. For example, a lead may be implantedwithin the heart so that lead electrodes, coupled to conductors carriedwithin a lead body, are positioned for proper sensing, efficient pacing,and defibrillation stimulation. A shadow area of the electrodes and theimplanted position of each electrode are factors determining a thresholdof shocking energy required to defibrillate the heart (defibrillationthreshold-DFT). One commonly used shocking vector is formed between aright ventricular (RV) defibrillation electrode and a device implantedwithin a left pectoral region (RV-can); another further includes a thirddefibrillation electrode positioned within the superior vena cava (SVC),which is electrically common with the can of the device (RV-SVC+can).

Improved electrodes for sensing and pulsing are desirable. For example,defibrillation may result in side effects, including both contractileand electrical dysfunctions. Therefore, reduction in defibrillationenergy is desirable. Electrodes that can reject unwanted signals wouldalso prove more efficient and could provide a means to apply the mostappropriate defibrillation shocks.

SUMMARY

The present technology includes systems, methods, articles ofmanufacture, and compositions that relate to implantable leads andelectrodes. In some embodiments, the present disclosure provides animplantable medical lead that has an elongated lead body with a distalend and a proximal end, where the lead includes a first material capableof electrical pulsing and sensing and a second material capable ofelectrical pulsing and not sensing. The first material and secondmaterial may be coupled to comprise an electrode and there may be aplurality of such first and second materials. The plurality of firstmaterials and the plurality of second materials may also be coupled tocomprise a plurality of electrodes, wherein the electrodes may compriseat least one first material and at least one second material. The leadmay further include one or more conventional electrodes.

In some embodiments, the present technology provides a method ofselectively sensing and pulsing electrical signals using an implantedmedical lead, the lead having an elongated lead body with a distal end,a proximal end, a first material capable of electrical pulsing andsensing, and a second material capable of electrical pulsing and notsensing. The method includes sensing an electrical signal using thefirst material and pulsing an electrical signal using the first materialand second material. Sensing an electrical signal using the firstmaterial may include sensing an electrical signal indicative of cardiacarrhythmia, ventricular fibrillation, or ventricular tachycardia andpulsing may provide pacing or a defibrillation shock.

Some embodiments include a second implanted medical lead, the secondlead having an elongated lead body with a distal end, a proximal end, afirst material capable of electrical pulsing and sensing, and a secondmaterial capable of electrical pulsing and not sensing, wherein pulsingcomprises pulsing an electrical signal using the first materials andsecond materials of the first lead and the second lead. Such pulsing maycreate at least one virtual electrode between the first and secondleads. The first and second leads may be further positioned so that theat least one virtual electrode blocks a reentrant electrical signal.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and do not represent all possible implementations,and are not intended to limit the scope of the present disclosure.

FIG. 1 illustrates a part of an implantable medical lead constructedaccording to the present technology;

FIGS. 2A, 2B, and 2C illustrate differential conduction pathways and theformation of virtual electrodes during phased pulsing between twoelectrodes constructed according to the present technology, eachelectrode having regions capable of pulsing and sensing that alternatewith regions capable of pulsing and not sensing;

FIG. 3 illustrates a grid of virtual electrodes formed between twoperpendicular electrodes constructed according to the presenttechnology;

FIG. 4 illustrates three electrodes constructed according to the presenttechnology that can form walls of virtual electrodes upon flippingpolarity to block reentrant loops following defibrillation; and

FIG. 5 illustrates an embodiment of an atrial synchronous ventricularinhibited pacemaker lead constructed according to the presenttechnology.

DETAILED DESCRIPTION

The following description of technology is merely exemplary in nature ofthe subject matter, manufacture and use of one or more inventions, andis not intended to limit the scope, application, or uses of any specificinvention claimed in this application or in such other applications asmay be filed claiming priority to this application, or patents issuingtherefrom. The following definitions and non-limiting guidelines must beconsidered in reviewing the description of the technology set forthherein.

The headings (such as “Introduction” and “Summary”) and sub-headingsused herein are intended only for general organization of topics withinthe present disclosure, and are not intended to limit the disclosure ofthe technology or any aspect thereof. In particular, subject matterdisclosed in the “Introduction” may include novel technology and may notconstitute a recitation of prior art. Subject matter disclosed in the“Summary” is not an exhaustive or complete disclosure of the entirescope of the technology or any embodiments thereof. Classification ordiscussion of a material within a section of this specification ashaving a particular utility is made for convenience, and no inferenceshould be drawn that the material must necessarily or solely function inaccordance with its classification herein when it is used in any givencomposition.

The citation of references herein does not constitute an admission thatthose references are prior art or have any relevance to thepatentability of the technology disclosed herein. All references citedin the “Detailed Description” section of this specification are herebyincorporated by reference in their entirety.

The description and specific examples, while indicating embodiments ofthe technology, are intended for purposes of illustration only and arenot intended to limit the scope of the technology. Moreover, recitationof multiple embodiments having stated features is not intended toexclude other embodiments having additional features, or otherembodiments incorporating different combinations of the stated features.Specific examples are provided for illustrative purposes of how to makeand use the apparatus and systems of this technology and, unlessexplicitly stated otherwise, are not intended to be a representationthat given embodiments of this technology have, or have not, been madeor tested.

As referred to herein, all compositional percentages are by weight ofthe total composition, unless otherwise specified. As used herein, theword “include,” and its variants, is intended to be non-limiting, suchthat recitation of items in a list is not to the exclusion of other likeitems that may also be useful in the materials, compositions, devices,and methods of this technology. Similarly, the terms “can” and “may” andtheir variants are intended to be non-limiting, such that recitationthat an embodiment can or may comprise certain elements or features doesnot exclude other embodiments of the present technology that do notcontain those elements or features.

“A” and “an” as used herein indicate “at least one” of the item ispresent; a plurality of such items may be present, when possible.“About” when applied to values indicates that the calculation or themeasurement allows some slight imprecision in the value (with someapproach to exactness in the value; approximately or reasonably close tothe value; nearly). If, for some reason, the imprecision provided by“about” is not otherwise understood in the art with this ordinarymeaning, then “about” as used herein indicates at least variations thatmay arise from ordinary methods of measuring or using such parameters.In addition, disclosure of ranges includes disclosure of all distinctvalues and further divided ranges within the entire range.

The present technology relates to electrical leads, such as pacing,sensing, and defibrillation leads, having electrodes operable toselectively sense and pulse. These leads may also be used to createvirtual electrodes within tissue. An electrical lead may include atleast one electrode where the electrode has at least two portions—oneportion that passes an electrical pulse and is not used for sensing, andanother portion that also passes an electrical pulse and is used forsensing. In this way, the electrode(s) on the electrical lead may bepositioned for localized sensing while providing a broader pulsing area.

The present leads and electrodes may be constructed in several ways. Insome embodiments, an electrical lead comprises first and secondmaterials, where the first material can deliver charge in the positiveand negative directions without restriction and can sense signals fasterthan the second material. The second material can also deliver charge,similar to the first material, but the second material may also eitherblock signals below a certain voltage level, analogous to a Zener diode,or may attenuate the signals, analogous to an electronic filter or aseries resistor, thereby allowing the first material to be the primarysensing source. The second material is also referred to herein as aselective sensing material.

In some embodiments, the electrode may be formed of a first material,which may be a conductive metal, where one or more portions are coveredwith the second material, which may be a selective sensing material suchas a valve metal. The exposed portion(s) of the conductive metal canboth sense and pulse while the valve metal coated portion(s) do notsense but can pulse. Alternatively, the electrode may be formed bycoupling a conductive metal portion to a valve metal portion. Forexample, a platinum wire coil may be electrically coupled to a tantalumwire coil.

Alternative electrode constructions may include multiconductor coilsformed of co-wound insulated wires with different electrical properties.A selective sensing electrode may be formed by exposing one wire type,formed of the first material, in a certain region and another wire type,formed of the second material, in a different region. For example, thepresent technology may include and/or modify features of the electrodesand leads as described in U.S. Pat. No. 5,336,253 to Gordon et al.; U.S.Pat. No. 5,342,414 to Mehra; U.S. Pat. No. 6,327,498 to Kroll; U.S. Pat.No. 5,531,782 to Kroll et al.; and U.S. Pat. No. 7,108,549 to Lyu et al.

Examples of the first material include good conductor metals such asplatinum, rhenium, vanadium, zirconium, palladium, iridium, titanium,niobium, tantalum, ruthenium, silver, molybdenum, silver chloride,cobalt, chromium, tungsten, magnesium, manganese, and their alloys.Examples of the first material also include nonmetals such as carbon,nitrides, conductive polymers, conductive ceramics and composites madeof combinations of these materials, including combinations of metals andnonmetals.

Examples of the second material (used in their native oxide form orsurface treated, i.e., anodized, doped, ion implanted, reactivesputtered, or any other chemical or physical treatment of the surface)include valve metals such as titanium, tungsten, chromium, aluminum,zirconium, hafnium, zinc, vanadium, niobium, tantalum, bismuth,antimony, and also include oxides, mixtures, and alloys thereof. Othermaterials that can be used to achieve selective sensing propertiesinclude metal oxides or mixtures of metal oxides, nitrides, carbides,semiconductors, conductive ceramics and ceramic oxides, conductiveglasses, conductive polymers, gels, polymer-metal composites, andceramic or glass composites. These various selective sensing materialsmay substitute for each other or may be used in combination as thesecond material. The second material may be further provided with anoxide coating (e.g., Ta₂O₅) which imparts useful properties such ascorrosion resistance, EMI (electromagnetic interference) isolation andelectrical resistance.

Additional examples of selective sensing materials include: tantalumpentoxide, titanium dioxide, niobium pentoxide, iridium oxide, p-typesilicon, n-type silicon, zirconium oxide, doped germanium, gray tin,selenium, zinc oxide, zinc sulfide, tellurium, boron-carbon,boron-silicon, boron-phosphorus, carbon-silicon, silicon-germanium,silicon-tin, germanium-tin, doped diamond, doped zirconia, dopedglasses, and organic rectifying materials such as polyacetylene,metal-phthalocyanine composites, poly(3,4-dicyanothiophene), and others.A specific example of how a material can be anodized to produce arectifying material which can be used for selective sensing is describedin the paper “Valve-metal type anodic oxide growth on iron disilicide(FeSi₂)”, Journal of Materials Science Letters by Ashok K. Vijh, GuyBélanger and R. Jacques of Institut de recherche d'Hydro-Québec, JOL 2POVarennes, Quebec, Canada. In some embodiments, where the first materialand second material comprise a similar or the same material, the secondmaterial may be anodized or treated to change its surface electricalproperties. For example, where the first material comprises titanium thesecond material may comprise anodized titanium, which does not have asgood of a conductive surface as the first material.

A defibrillation electrode, for example, may be fabricated with tantalumpentoxide (Ta₂O₅) and platinum/iridium (Pt/Ir), or similar metalcouples, as an integrated bipolar defibrillation electrode. The entireelectrode can be used to pass charge while only the portion containingthe Pt/Ir can be used for sensing, thus effectively rejecting unwantedsignals. Due the valve metal characteristics of the Ta₂O₅, the Ta₂O₅portion(s) of the electrode conducts differently when used anodicallyand cathodically, which may further create an increase in the complexityof the intracardiac gradient and may be used to present one or morevirtual electrodes within tissue. For example, an electrical lead mayinclude one or more electrodes, where each electrode may include one ormore materials capable of pulsing and sensing (e.g., Pt/Ir) and/or oneor more materials capable of pulsing and not sensing (e.g., Ta₂O₅).

In some embodiments, electrodes and leads constructed according to thepresent technology can allow precise sensing and can also reducedefibrillation thresholds. For example, improved sensing is achieved byrejecting unwanted signals via proper placement of the sensing portion.This may be used to produce “true bipolar” functionality in anintegrated bipolar lead design. The present design may also eliminateone circuit, using only two versus the three required in a conventionaltrue bipolar defibrillation lead. What is more, spacing and patterns ofTa₂O₅ and Pt/Ir on the electrodes can reduce the defibrillation energyrequired to reach the DFT. These patterns may also be used to createcomplex electrical gradients and virtual electrodes within the tissue,reducing defibrillation energy and improving the pinning of reentrantcircuits post-shock.

Virtual electrodes and how they relate to defibrillation are illustratedin Efimov et al., Virtual electrode hypothesis of defibrillation, HeartRhythm, Vol. 3, No. 9 (September 2006) and Hayashi et al., VirtualElectrodes and the Induction of Fibrillation in Langendorff-PerfusedRabbit Ventricles: The Role of Intracellular Calcium, Am. J. Physiol.Heart Circ. Physiol. (Aug. 1, 2008), the relevant portions of which areincorporated herein by reference.

The terms “virtual electrode” and “activating function” are both used torefer to the driving force that drives transmembrane potential in eithera depolarizing (positive) or hyperpolarizing (negative) direction afteran externally applied electric field. A unipolar stimulus may produceboth positive and negative polarization in a two-dimensional syncytium.These positive and negative polarizations are considered to be inducedby virtual cathodes and virtual anodes, respectively. The virtualelectrode theory predicts that an externally applied electric field cangenerate positive and negative virtual electrodes, which can depend onboth the field configuration and tissue structure.

Basic mechanisms of ventricular tachycardia and fibrillation (VT/VF) canbe addressed in the following ways: (1) defibrillation shock shouldterminate all or most wave fronts that sustain VT/VF; (2) the shockshould not reinduce VT/VF; (3) the shock may need to suppress sources ofVT/VF if they are focal in nature; and (4) the shock should not suppresspostshock recovery of the normal sinus rhythm.

A strong electric shock applied during the refractory period can extendrefractoriness. Thus, VT/VF wave fronts may be extinguished by eitherdirect stimulation of excitable tissue or by extending the refractoryperiod of depolarized tissue. In terms of virtual electrodes, these twophenomena are explained by the virtual cathode effect. With respect tothe virtual anode, virtual anodes exist during defibrillation shocks andhave effects on post-shock electrical activity. When applied torefractory myocardium, virtual anodes may de-excite cells and may eithershorten the refractory period or fully restore excitability. Whenapplied to excitable myocardium, virtual anodes hyperpolarize thetissue, but this hyper-polarization may be rapidly overwhelmed bydepolarization produced by nearby virtual cathodes.

Shock-induced reentry may be induced by an adjacent virtual anode andvirtual cathode. The anode de-excites tissue and restores excitability,while the cathode depolarizes tissue. When the two are within one spaceconstant, a strong gradient of transmembrane potential is created, whichmay result in a post-shock wave front of break excitation. This wavefront may propagate within the de-excited area of the virtual anode,and, if there is sufficient time for recovery of unaffected tissue andtissue subjected to virtual cathode-induced depolarization, this wavefront may reenter and form arrhythmia circuit(s).

The defibrillation threshold may have a magnitude similar to the upperlimit of vulnerability (ULV). Shocks larger than the ULV may inducestronger de-excitation, which accelerates conduction of the post-shockwave front of break excitation, leaving insufficient time for recoveryof myocardium depolarized by virtual cathodes and rendering reentryessentially impossible.

Clinical implications of virtual electrodes in defibrillation includethe following aspects. Anodal shocks may perform better compared tocathodal shocks, as applied from defibrillation leads. The virtualcathodes created adjacent to the real anode during anodal shocks canproduce wave fronts that propagate inward, toward the area ofde-excitation. These wave fronts can frequently collide and annihilateeach other, whereas positive polarization under the real cathode duringcathodal shocks can create wave fronts that propagate outward, having agreater propensity to return and create sustained reentry.

The efficacy of different waveforms also affects virtual electrodes anddefibrillation. Biphasic shocks can have a lower defibrillationthreshold than monophasic shocks. Monophasic shocks can be greater thanthe ULV to avoid the creation of a shock-induced phase singularity,which may reinduce reentry. On the other hand, the second phase ofbiphasic shocks can act to reverse the first-phase polarization, thuseliminating the substrate for postshock reentry. Monophasic ascendingdefibrillation waveforms may also be better than descending waveforms.Ascending waveforms produce maximum polarization at the end of theshock. Therefore, break excitation resulting from these shocks is likelyto produce faster propagation into the de-excited regions and will notform reentry. However, descending waveforms tend to reach maximumpolarization before the end of the shock and typically have a lowerpolarization at shock end, contributing to slower conduction andproviding the substrate for shock-induced reentry.

Reentrant VT may be pinned or anchored at a functionally or anatomicallyheterogeneous region, which comprises the core of reentry. Virtualelectrode polarization and the activating function suggest that areasnear the core may experience greater polarization in response to anapplied electric field compared with surrounding, and more homogeneous,tissue. Thus, the core of reentry can be preferentially excited withvery small electric fields to destabilize and unpin reentrant VT fromits stationary core. However, the external field should be applied atthe right moment for the virtual electrode-induced excitation toproperly interact with and terminate VT. For example, about a 20-foldreduction in defibrillation energy may be obtained with this unpinningmethod as compared with conventional defibrillation. This new low-energyapproach may alleviate many of the side effects currently associatedwith strong electric shocks.

Referring now to FIG. 1, a bipolar design for a right ventricular lead100 is shown. The lead 100 includes a body 110, constructed for examplefrom insulating tubing, a connector (not shown) at a proximal end forcoupling to an IMD, and a tip 120 at a distal end, which may includetissue attachment means, such as a screw, one or more barbs or anchormembers, an adhesive, etc. The lead body 120 contains insulatedconductors (not shown) which extend from the connector to an electrode130. The electrode 130 may include a defibrillation coil formed ofplatinum or or a platinum alloy (e.g., Pt/Ir) having a Ta2O5 coating ona proximal portion 140 of the defibrillation coil, with the platinumexposed on a distal portion 150 of the lead.

The platinum distal portion 150 of the lead 100 is selectively placed toeither mimic a bipolar sensing ring's size and location, or to produceprecise sensing from another location along the length of the coil. Forexample, the platinum distal portion 150 may replace the ring electrode,as used in an RV lead constructed according to U.S. Pat. No. 7,236,828to Casavant et al., or may be used in conjunction with such a ringelectrode. Other configurations that may be adapted to include thepresent leads and electrodes include those illustrated in U.S. Pat. No.5,336,253 to Gordon et al.; U.S. Pat. No. 5,342,414 to Mehra; U.S. Pat.No. 6,327,498 to Kroll; and U.S. Pat. No. 5,531,782 to Kroll et al.

During sensing, the platinum distal portion 150 can detect the localvoltage thereby limiting the sensing to the platinum distal portion 150of the electrode 130. The Ta2O5 coated proximal portion 140 filters outthe sensed signal due to its high impedance, allowing the capturing ofthe evolved response by the platinum distal portion 150. Duringdefibrillation shock, however, the Ta2O5 coating is overwhelmed by thedelivered voltage and both the Ta2O5 coated proximal portion 140 and theplatinum distal portion 150 conduct the current associated with theshock. The Ta2O5 coated proximal portion 140 may not conduct at pacingvoltages.

In some embodiments, an electrode or a portion of an electrode, such aswire coil, may include Ta2O5 coated or anodized Ta wire. The Ta2O5coated electrode or electrode portion may be used on the proximal end ofan RV defibrillation coil to mitigate P-wave oversensing. The Ta2O5electrode or electrode portion may also be used on the proximal end ofan SVC coil to increase the distance between the active can electrodeand the active sensing portion of the SVC coil for improved pseudoelectrocardiogram (ECG) performance. P-wave oversensing and SVC coilsare illustrated, for example, in U.S. Pat. No. 7,236,828 to Casavant etal.

In some embodiments, an electrical lead includes selective masking ofadditional defibrillation electrodes using a coating such as Ta2O5, andmay include additional masking of the right ventricular coil. Theplatinum and Ta2O5 coated portions or an electrode may be alternated,resulting in striped or banded electrodes. Or, multiple electrodes maybe used, where each electrode includes platinum and/or Ta2O5. When adefibrillation shock is delivered, typically in a biphasic form, thesealternating regions result in differential conduction depending on theamplitude of the shock and its polarity. The result is the creation ofcomplex gradients and virtual electrodes within the tissue that canreduce the defibrillation threshold (DFT) and increase pinning ofreentrant circuits.

Referring now to FIG. 2A, a pair of electrodes 200 is shown where afirst electrode 210 is operating as a cathode and a second electrode 220is operating as an anode. Each of the first and second electrodes 210,200 comprise platinum 230, or a platinum alloy, with alternating Ta2O5coated portions 240. The alternating platinum 230 and Ta2O5 coatedportions 240 result in differential conduction pathways, represented bylines 250, between the first and second electrodes 210, 220.

Referring now to FIG. 2B, a first phase of a biphasic defibrillationshock between the pair of electrodes 200 is shown. Conduction occursbetween the first electrode 210, presently operating as a cathode, andthe second electrode 220, presently operating as an anode 220. Followingthe differential conduction pathways 250, first virtual electrodes 260are formed within the tissue between the first and second electrodes210, 200.

Referring now to FIG. 2C, a second phase of the biphasic defibrillationshock between the pair of electrodes 200 is shown. Polarity is flippedsuch that the first electrode 210 now operates as the anode and thesecond electrode 220 now operates as the cathode. Following reverseddifferential conduction pathways 270, second virtual electrodes 280 areformed between the first and second electrodes 210, 200. Biphasicdefibrillation shock may therefore create a “wall” of depolarizationbetween the pair of electrodes, illustrated by the sum of FIGS. 2B and2C, which includes the first and second virtual electrodes 260, 280.This wall of depolarization may act as a barrier to stop reentrantloops.

Referring now to FIG. 3, a grid 300 of virtual electrodes 310 formedwithin tissue is shown. The grid 300 results from two perpendicularelectrodes 320 having alternating exposed platinum portions 330 (orplatinum alloy) and Ta2O5 coated portions 340.

Referring now to FIG. 4, a system 400 including three electrodes isshown. The system 400 has first and second electrodes 410, 420 operatingin concert and illustrated as cathodes, and a third electrode 430illustrated as an anode. Upon conduction of an electric pulse andsubsequently flipping polarity, a “wall” of virtual electrodes 440 isformed within the tissue between each of the first and second electrodes410, 420 and the third electrode 430. Thus, the first and secondelectrodes 410, 420 (optionally including additional electrodes, notshown) may be used to cordon off areas of tissue relative to the thirdelectrode 430, operating as a barricade to inhibit reentrant loopsthrough the virtual electrode wall in the tissue.

In some embodiments, the present technology includes an atrialsynchronous ventricular inhibited (VDD) pacemaker ICD lead. The VDD ICDlead functions to sense cardiac activity in both the right atrium andventricle combined with the ability to pace the cardiac rate from theventricle. For example, this functionality is demonstrated by theMedtronic Model 5038 bipolar sensing (A & V) and bipolar pacing (V)lead. The VDD ICD lead, such as Model 14108 for DDD ICD leads, combinesthe sensing and pacing functions onto a single defibrillation electrode(e.g., single coil) ICD lead such as Medtronic models 6932, 6943, 6930,6932, and 6935, and see those illustrated in U.S. Pat. No. 5,676,694 toBoser et al. The present technology improves these leads by includingone or more electrodes capable of selective sensing and pacing.

Referring now to FIG. 5, an embodiment of a VDD pacemaker ICD lead 500constructed according to the present technology is shown. A“pseudo-bipolar” electrode construction includes a region of Pt/Ir coilor ring electrode 510 and a length (e.g., 5-20 cm) of Ta wire coilelectrode 520 with a Ta2O5 coating/layer. For example, thepseudo-bipolar electrode may be used in place of a proximal atrialelectrode in a VDD pacemaker ICD lead. This provides the ability tomaintain dual coil lead functionality that is used by the majority ofelectrophysiologists without sacrificing the specificity of atrialsensing, such as sensing that may be achieved with the Medtronic model5038 or Model 14108 lead. The lead 500 also includes a proximal atrialelectrode 530 having a Pt/Ir portion 540 and a Ta portion 550 with aTa2O5 coating.

The VDD pacemaker ICD lead 500 may include four connections: (1) RV tipconnector (e.g., low voltage unipolar IS-1 standard connector, ISOstandard 5841-3); (2) connector for coated ventricular defibrillationcoil with combined low voltage portion for sensing (e.g., Pt) and highvoltage portion for defibrillation (Ta2O5), where the connector may besimilar to those used for defibrillation leads with integrated bipolarsensing (e.g., DF-1 standard connector ISO standard 11318); (3)connector for an atrial pace/sense ring; and (4) connector for an atrialpace/sense ring or tip (as in Medtronic lead models 14107 and 14108);for example, (3) and (4) may be combined in a bipolar IS-1 connector.

Referring again to FIG. 5, a first connector 560 may include an RV tipconnector. A second connector 570 may include a connector for the coatedventricular defibrillation coil with combined low voltage portion forsensing (i.e., Pt/Ir coil electrode 510) and high voltage portion fordefibrillation (i.e., Ta wire coil electrode 520 with a Ta2O5coating/layer). And a third connector 580 may include an atrialpace/sense ring or tip for the proximal atrial electrode 530 having aPt/Ir portion 540 and a Ta portion 550 with a Ta2O5 coating.

The present leads can further improve on previous leads where thedefibrillation coil is connected to both a low voltage connector (e.g.,IS-1) and a high voltage connector (e.g., DF1), since the present leadsallow use of a single connector, with connections to the sensing anddefibrillator circuits made inside the ICD.

Connections (1) through (4) may also be realized by an IS-4 connector,as illustrated in U.S. Published Patent Application 2005/0221671A1 toLyu et al., which comprises three low voltage connections and one highvoltage connection. The present partially coated coil, allowing truebipolar ventricular sensing, makes the concept of a single pass dualchamber lead even more attractive. This configuration has the advantageof a single, high voltage coil which reduces leakage current and therisk of interference between high and low voltage signals via theconnector sealings. The configuration also maintains the advantage ofdual chamber sensing using a single lead, which may reduce inappropriateshocks and thromboembolic complications.

In some embodiments, a selective sensing and pulsing lead includes apartially coated ventricular defibrillation coil for true bipolarsensing and defibrillation and a configuration of atrial sensingelectrodes as present in Medtronic model 5032/5038 VDD pacing leads ormodel 14108 DDD defibrillation lead. For example, the partially coatedventricular defibrillation coil may include a platinum wire coilelectrode with a Ta2O5 coating/layer, as described herein. The atrialsensing electrodes may include a selective sensing portion, as well.

The present technology affords several benefits and advantages. Thepresent systems and methods improve leads and electrodes by providingrectifying coatings to selectively sense with portions of an electrodecoil, while pulsing with a larger contact area, and can further allowthe creation of complex defibrillation fields, including virtualelectrodes. The present electrodes and leads may reduce the chance ofadministering inappropriate defibrillation shocks. For example, oneadvantage of the present electrode and lead configurations is thatsingle chamber pacing/defibrillation is combined with dual chambersensing of atrial and ventricular signals. As a result, inappropriatedetection of ventricular tachyarrhythmia may be reduced and consequentlythe administration of inappropriate shock may be reduced. The presentelectrode and lead configurations may also be implemented as single passVDD or DDD defibrillation leads, depending on the ability of the atrialsense rings to provide reliable atrial pacing. The present electrodesalso overcome limitations of integrated bipolar electrodes that use theentire coil for shocking and sensing. In addition, an implantable leadhaving one of the present electrodes, for example having a Ta2O5 portionand a Pt/Ir portion, can take the place of a lead having separateelectrodes for pulsing and sensing in any IMD using such leads. Thepresent leads and electrodes therefore reduce complexity and may reducethe number of conductors and connections required in lead manufacture.

Those of skill in the art will recognize that many of the embodimentsand techniques provided by the present technology may be used, asapplicable, in various implantable medical devices for treatment ofvarious tissues. That is, the present teachings are not limited tocardiac applications and should be fairly construed to include leads andelectrodes for other types of devices, such as deep brain stimulationleads, neurostimulation leads for pain and interstim applications,external sensing electrodes for EKG and ECG applications, etc. Inaddition, the embodiments and the examples described herein areexemplary and not intended to be limiting in describing the full scopeof apparatus, systems, and methods of the present technology. Equivalentchanges, modifications and variations of some embodiments, materials,compositions and methods can be made within the scope of the presenttechnology, with substantially similar results.

What is claimed is:
 1. A method of selectively sensing and pulsing electrical signals using an implanted medical lead, the lead having an elongated lead body with a distal end, a proximal end, a first material capable of electrical pulsing and sensing, and a second material capable of electrical pulsing and not sensing, the method comprising: sensing an electrical signal using the first material; pulsing an electrical signal using the first material and the second material.
 2. The method of claim 1, wherein the second material comprises a valve metal.
 3. The method of claim 2, wherein the valve metal is selected from the group consisting of titanium, tungsten, chromium, aluminum, zirconium, hafnium, zinc, vanadium, niobium, tantalum, bismuth, antimony, oxides thereof, alloys thereof, and combinations thereof.
 4. The method of claim 1, wherein the first material comprises platinum or alloys thereof.
 5. The method of claim 1, wherein pulsing an electrical signal using the first material and the second material comprises providing a defibrillation shock.
 6. The method of claim 1, wherein the first material comprises a plurality of first portions, and sensing an electrical signal using the first portions comprises sensing an electrical signal from at least two of the first portions.
 7. The method of claim 6, wherein one of the two first portions is located in an atrium and the other one of the first portions is located in a ventricle.
 8. The method of claim 1, further comprising a second implanted medical lead, the second lead having an elongated lead body with a distal end, a proximal end, a first material capable of electrical pulsing and sensing, and a second material capable of electrical pulsing and not sensing, wherein pulsing comprises pulsing an electrical signal using the first materials and second materials of the first lead and the second lead.
 9. The method of claim 8, wherein the pulsing comprises providing a defibrillation shock.
 10. The method of claim 8, wherein the pulsing creates at least one virtual electrode between the first and second leads.
 11. The method of claim 10, wherein the first and second leads are positioned so that the at least one virtual electrode blocks a reentrant electrical signal.
 12. The method of claim 8, wherein the pulsing comprises providing a biphasic electrical signal.
 13. The method of claim 1, wherein sensing an electrical signal using the first material comprises sensing an electrical signal indicative of cardiac arrhythmia, ventricular fibrillation, or ventricular tachycardia.
 14. A method of selectively sensing and pulsing electrical signals using an implanted medical lead, the lead having an elongated lead body with a distal end, a proximal end, an electrode comprising a first external surface portion of a first material capable of electrical pulsing and sensing, and a second external surface portion of a second material capable of electrical pulsing and not sensing, the method comprising: sensing an electrical signal using the first material; pulsing an electrical signal using the first material and the second material.
 15. A pacemaker lead having an elongated lead body with a distal end and a proximal end, the lead comprising: a connector at the proximal end; and a first electrode and a second electrode, the first electrode positioned closer to the distal end than the second electrode; wherein the first electrode comprises a first external surface portion of a first material capable of electrical pulsing and sensing and a second external surface portion of a second material capable of electrical pulsing and not sensing. 